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See the opportunities and challenges organizations face in addressing the patient experience.

Case Studies provide real stories of current efforts, including programs being initiated, practices being implemented, and outcomes being targeted and/or achieved. Case studies are presented as both an opportunity for learning from others as well as a spark for further ideas on how we work to improve the patient experience. If you have a case study to share please contact us.

What was the challenge, opportunity or issue faced?

In pursuing the Triple Aim dimensions (improving the health of populations, reducing the per capita cost of healthcare and enhancing the patient experience of care), there is a lot of talk about technology as the solution. An electronic portal, for instance, is often thought of as ‘the’ patient engagement solution. However, it is only one tool and a means to an end. So, in all that talk, we must not lose sight of the patient experience. True patient engagement involves so much more than technology. The relationships patients have with all levels of the healthcare system create the patient experience and profoundly influence their willingness to engage. Those relationships are a very non-clinical piece to the healing puzzle, but those relationships are the heart of medicine.

Allina Health has one of the most comprehensive electronic health record systems in the nation. This helps give patients seamless, coordinated and more informed care. Remember though, that not all patients are technologically savvy or want to be. It is one thing when a provider tells a patient that his test results will be available online. It is quite another when someone from that provider’s office shows the patient how to access and sign up for their portal, teaches him how to receive and review those results, and offers encouragement around the electronic process. Even if the technology exists, the patient experience can suffer if providers and/or their designees do not encourage, enable and support the processes.

To address the heart of medicine Allina wanted to leverage both high tech and high touch patient experience and engagement strategies to achieve the Triple Aim’s dimension around the patient care experience.

What did you do to address it?

Allina Health implemented the Care Guide, LifeCourse and Online Healthcare Directive initiatives - all aimed at improving the patient experience and engaging patients in their care at a reasonable cost.

The Care Guide program, made possible by a grant from the Robina Foundation, introduced a new type of clinic employee: a lay healthcare worker, whose job is to help patients and providers achieve care goals recommended by national authorities. The care guide provides important personal interactions that encourage patients to adopt healthier behaviors and to help time-pressed healthcare providers improve care quality. Care guides assist patients in achieving care goals by bridging patient-provider communication, ensuring continuity of care and helping to find the resources necessary to provide/obtain ideal care.

The LifeCourse research project, also made possible by a grant from the Robina Foundation, offers Allina Health the opportunity to transform the end-of-life experience for patients and their families. LifeCourse moves patient-centered care into the mainstream for adults living with advanced illness in the last two to three years of life by developing a model that delivers supportive care to individuals based on their wishes.

The LifeCourse program began in early 2013 after a four-month preliminary trial and includes 400 to 500 individuals living with dementia, late stage cancer, and heart failure. This program focuses on the whole-person approach to supporting patients as they face challenges with their progressing illnesses. The distinguishing feature of the LifeCourse care model is the relationship with a care guide.

The LifeCourse project takes care guides out of the clinic and moves them into the community, visiting patients at their homes, assisted living apartments, or nursing homes. The care guide is the connector who builds a relationship with patients and records their personal goals and wishes (both health related and non-health related). Patients’ non health-related goals may include returning to independent living, healing a fractured relationship, living to see a child graduate, or walking a child down the aisle at their wedding. The care guide is backed by a team of clinical professionals (e.g., a nurse, pharmacist, social worker, chaplain, and marriage and family therapist) that connect with patients, as appropriate, and help move them forward in meeting their goals.

The LifeCourse project offered an opportunity to begin the latest example of Allina Health’s mission to enhance patient engagement. This provides a way for patients to create a healthcare directive online. Allina purchased, enhanced and implemented an electronic advance care planning tool to ensure that ACP processes are effectively standardized and integrated into the fabric of medical care across its facilities.

What were the outcomes?

Care Guide Initiative:
Patients reported a high degree of satisfaction with this program and easily understood the care guide role. After one year, 90 percent of patients reported that they wanted to continue working with a care guide. In feedback sessions, doctors and nurses were initially skeptical about the potential value of care guides, but became enthusiastic after a few months, listing interdependent teamwork, information sharing, reminders, and helpful division of labor as positive aspects of working with care guides.

In addition, patients working with care guides were 31 percent more likely than control patients in the study to meet evidence-based goals and 21 percent more likely to quit tobacco use. There was also significant improvement in all diagnosis groups across demographic categories.

Care guides improved quality by serving as live quality improvement agents able to communicate nuances in care and patient progress, rather than a monthly report or pop-up EHR reminder. Care guides communicated missing tests and any issues to providers with an informal discussion on the day of the appointment. They were able to personally target patients who were not meeting care goals. In after-study surveys, care guide patients reported significantly more positive perceptions of their care than control patients in constructs measuring social support, individualized care, help, reinforcement, and understanding of how to improve their health.

Care guides could each manage 190 patients, which allowed the clinics to maintain traditional roles and create efficiencies in workflows. The nurses and doctors embraced this new position as they were able to focus on their core competencies and duties. A care guide’s salary and benefits cost $286 per patient per year, a low cost and potentially affordable option for clinics when the achieved benefits are considered.

The LifeCourse Project:

In LifeCourse’s first year, researchers learned that patients and their families appreciated the chance to share their story with a skilled, compassionate listener. Physicians expressed appreciation for the work of the care guide, who helped them get to know their patients better. LifeCourse researchers are aiming to determine relevant outcomes for both the clinic and the quality of life for patients. For clinical outcomes, the study is measuring patient goals honored, inpatient days, hospital enrollment, and hospice days. Patient outcomes being measured include the patient and caregiver experiences and quality of life.

Online Healthcare Directive:

Implementing the Online Health Care Directive provided Allina Health with the opportunity to transform the experience of creating a health care directive for patients and their families and positively impact Allina’s Care strategy in the following areas:

Patient experience: The Online Health Care Directive promotes patient engagement and improves the care experience and quality of life for patients and their families by helping to ensure that individual wishes are clearly understood and consistently honored at the end of life.

Community Engagement: The Online Health Care Directive cross functional team intentionally engaged partners throughout all of Allina Health, as well as patients and families, to assist in optimal design and implementation.

Financial Health: The culture of shared decision making utilized for Advance Care Planning has been proven to result in not only greater patient and family satisfaction, but also a reduction in the amount of over or under treatment a person receives, which can lower the overall healthcare costs during the last months of life.

Service Enhancement/Operational Excellence: The online healthcare directive has helped process efficiency and clinical quality across the system and supports ambulatory providers by bringing to the forefront their patients’ goals and wishes as they move among care sites in the system. This has enhanced the efficiency of both affiliated and independent primary providers and specialists caring for complex patients through virtual interdisciplinary care teams. Advance care planning, if done well, can assist the care team to provide the specific level of care desired by the patient at the right time and right place. In addition, the gold standard of geriatric and palliative care is early and ongoing attention to advance care planning.

Case study shared by Kimberly Radel, Allina Health, and Kathy Krypel, Aspen Advisors, Part of The Chartis Group. Radel and Krypel will be presented more about this case study in a webinar hosted by The Beryl Institute: "Patient Experience: Touching the Heart of Medicine."

About Allina Health

Allina Health, a not-for-profit healthcare system serving Minnesota and western Wisconsin, cares for patients from beginning to end-of-life through its 13 hospitals, 14 retail pharmacy sites, more than 90 clinics and 26,405 employees.